In reply to Re: Alpha-delta sleep and cymbalta? » Christia, posted by floatingbridge on March 27, 2011, at 10:30:42

Thanks for the responses! My pdoc ordered the test because of my complaints of fatigue on 60 mgs. I take no other medicines at the moment, except a flintstones vitamin (all the stomach can handle).

I thought the fatigue might be that I was missing REM sleep since if I forget a dose I have wild dreams--like a rebound.

I see the pdoc in 1.5 weeks, but my follow-up at the sleep clinic is not until June. I do have a chronic pain disorder (not fibro or CFIDS), but I was not in a great deal of pain during the night of the study. The alpha-delta can be associated with alpha-delta, but they it's unclear whether its cause of effect.

In the meantime, I'm down to 30 mg. Still tired, but who knows how long it'd take to be better if it were the meds.

> Christia,> > Do you use any other medication? Or sleep aid? Those sleep aids can alter sleep architecture significantly.> > I'm assuming the sleep study place made no comments or suggestions regarding medication and sleep. > > Who ordred the test? I would hope they would have some good answers for you.> > Please post back what you hear, would > you? Good luck with this.

In reply to Re: Alpha-delta sleep and cymbalta? » Christia, posted by floatingbridge on March 27, 2011, at 10:30:42

Thanks for the responses! My pdoc ordered the test because of my complaints of fatigue on 60 mgs. I take no other medicines at the moment, except a flintstones vitamin (all the stomach can handle).

I thought the fatigue might be that I was missing REM sleep since if I forget a dose I have wild dreams--like a rebound.

I see the pdoc in 1.5 weeks, but my follow-up at the sleep clinic is not until June. I do have a chronic pain disorder (not fibro or CFIDS), but I was not in a great deal of pain during the night of the study. The alpha-delta can be associated with pain syndromes, but they it's unclear whether its cause or effect.

In the meantime, I'm down to 30 mg. Still tired, but who knows how long it'd take to be better if it were the meds.

> Christia,> > Do you use any other medication? Or sleep aid? Those sleep aids can alter sleep architecture significantly.> > I'm assuming the sleep study place made no comments or suggestions regarding medication and sleep. > > Who ordred the test? I would hope they would have some good answers for you.> > Please post back what you hear, would > you? Good luck with this.

In reply to Re: Alpha-delta sleep and cymbalta? » floatingbridge, posted by Christia on March 27, 2011, at 12:25:02

Christia, recently had a failed trial of cymbalta for double-duty AD & chronic pain. Impacted sleep greatly, negatively affected depression, and gave me intractable GI issues. (I hung on for about 8 weeks to wrangle the GI issue because it reduced the *other* pain so successfully.)

My dreaming and sleep altered quite a bit, though; more than pristiq. I, too, wonder about a med that disrupts the stages of sleep in which the body repairs tissues, including nerves....

So, no less pain now, but maybe, deep sleep/health deficit down the road? Medications can prompt some difficult decisions.

In reply to Re: Alpha-delta sleep and cymbalta? » Christia, posted by floatingbridge on March 27, 2011, at 17:28:18

They sure do prompt difficult questions. Have you had success with other meds or med combos for the pain/depression one-two punch?

Effexor worked for me for depression, but caused me to to have to sleep 12 hours per night. (And I mean I HAD to!) I won;t even try pristiq, since it's basically effexor.

Lyrica for pain made me completely depressed within a week, even though the pain docs said this was not a SE (except for the suicide warning of course). The physical pain was almost magically gone, however.

While I am always grateful for meds that make me feel better, I'm always constantly aggravated as well. I wish I did not always get the side effects!

On a side-note. I saw that agomelatine works in part by increasing slow-wave sleep. I am half-ready to import it now!

Thanks.

> Christia, recently had a failed trial of cymbalta for double-duty AD & chronic pain. Impacted sleep greatly, negatively affected depression, and gave me intractable GI issues. (I hung on for about 8 weeks to wrangle the GI issue because it reduced the *other* pain so successfully.)> > My dreaming and sleep altered quite a bit, though; more than pristiq. I, too, wonder about a med that disrupts the stages of sleep in which the body repairs > tissues, including nerves....> > So, no less pain now, but maybe, deep sleep/health deficit down the road? Medications can prompt some difficult decisions.> > fb

In reply to Re: Alpha-delta sleep and cymbalta? » floatingbridge, posted by Christia on March 27, 2011, at 12:25:02

IN general, antidepressants improve sleep architecture. Problems with 'delta' or deep sleep are common in depression. Dreaming mostly occurs in REM, and excess REM occurs with depression. The rebound effect is an exaggeration of hte problem you had without the antidepressant.

Something like trazadone would be ok, except if you have problems with fatigue already, a long-half-life drug that is mostly sedative is probably going to make sleepiness worse.

It might be the sri effect of the cymbalta that is causing fatigue. Is it a lassitude and indifference? I'd say switch from cymbalta to nortriptaline; it has less sri effect, and 5ht2 antagonism that also improve sleep architecture.

In reply to Re: Alpha-delta sleep and cymbalta? » desolationrower, posted by Christia on March 30, 2011, at 15:48:28

> Thanks for the info! I can't handle Tricyclics well at all, but do you think milnacipran and melatonin would work?

yes, i think that would be close to as good. 5ht2c inhibition is about 2x as effective as 5ht2a inhibition. I would worry that it won't help the fatigue, if it is the sri effect of duloxetine that is causing it. have you ever taken an ssri, and did you have fatigue?

which TCA did you try before? desipramine and notriptyline have less side effects than some of the others.

You could also ask about cyproheptadine. it is an antihistamine as well as 5ht2 antagonist, but it has a reasonably short half-life.

In reply to Re: Alpha-delta sleep and cymbalta? » Christia, posted by desolationrower on March 30, 2011, at 21:15:58

Hi,

I've tried imipramine, desipramine, and one other (not sure which--long time ago).

I seem to be incredibly sensitive to meds. I tried every one of the SSRIs in turn. None worked for me. Most made me sleepy, some more than others. Effexor made me super-tired but at least worked on the depression. Had to sleep 10 hours/night on 37.5 and 12 on 75 mgs. I was a grad student at the time so I could actually live with that.

Cymbalta has been by far the best, has always made me somewhat fatigued but that seems worse now. I'm not sure why that would be?

This site is great! So much knowledge. I have to look up 5ht2c and 5ht2a to see what they are. Had to look up cyproheptadine as well. WOuld this be to improve sleep?

Thanks again!

> yes, i think that would be close to as good. 5ht2c inhibition is about 2x as effective as 5ht2a inhibition. I would worry that it won't help the fatigue, if it is the sri effect of duloxetine that is causing it. have you ever taken an ssri, and did you have fatigue?> > which TCA did you try before? desipramine and notriptyline have less side effects than some of the others. > > You could also ask about cyproheptadine. it is an antihistamine as well as 5ht2 antagonist, but it has a reasonably short half-life. > > -d/r

In reply to Re: Alpha-delta sleep and cymbalta? » mtdewcmu, posted by floatingbridge on April 1, 2011, at 0:52:41

> :D> > I'm smiling at one of those *elementary my dear Watson* moments.> > Yeah, guess that about sums it up for me.> > Cymbalta was a real sleep disaster followed by Lyrica which placed me in a permanent trance....so fibro flare supreme right now.> > Thanks for this.> > fb

Sure. Life is miserable when you can't get good sleep. I tried going down to 10mg of Paxil and after a couple weeks I started waking up feeling like I hadn't even slept. Life becomes nearly impossible to deal with when you never feel refreshed and one day runs into the next. It's scary to think that I used to live like that when I had untreated depression.

In reply to Re: Alpha-delta sleep and cymbalta?, posted by mtdewcmu on April 1, 2011, at 0:57:44

I can't quite do the math tonight. Can I run this past you?

I still remember experiencing my first anti-depressant for the first time. It was zoloft (and depakote). I thought I was on an acid trip for the first two days. Surely I would never be able to function, drive a car, much less stand up.

The next week, I remember staring at a red pear in the market. How could I have forgotten the beauty of it, of everything?

What was that iyho? Why so acidy? (Not mania like scrubbing the grout of my bathroom w/a toothbrush, nor any grand plans. Just a week of one big giant *wow*.)

> This site is great! So much knowledge. I have to look up 5ht2c and 5ht2a to see what they are. Had to look up cyproheptadine as well. WOuld this be to improve sleep?> > > > Here's what I know about 5-ht2a/c in a nutshell:> > 5-ht stands for serotonin, which is also known as 5-hydroxytryptamine.> > 5-hta/c are 5-ht receptors. So they are like buttons that are pressed by 5-ht. Having lots of 5-ht around due to an SSRI means they get pressed more often. Here's what they do:> > 5-ht2a is the receptor for psychedelic drugs and causes hallucinations. Newer antipsychotics block it.> > 5-ht2c is thought to cause a lot of SSRI side effects, like anxiety and agitation.> > Blocking those receptors is thought to have an antidepressant effect.> > Actually, that's not *everything* I know, but that's what's pertinent to the discussion.

In reply to Re: Alpha-delta sleep and cymbalta? » mtdewcmu, posted by floatingbridge on April 1, 2011, at 1:50:19

> I can't quite do the math tonight. Can I run this past you?> > I still remember experiencing my first anti-depressant for the first time. It was zoloft (and depakote). I thought I was on an acid trip for the first two days. Surely I would never be able to function, drive a car, much less stand up.> > The next week, I remember staring at a red pear in the market. How could I have forgotten the beauty of it, of everything?> > What was that iyho? Why so acidy? (Not mania like scrubbing the grout of my bathroom w/a toothbrush, nor any grand plans. Just a week of one big giant *wow*.)> >

I felt like that when I first took Prozac. It must be 5-ht2a stimulation.